Analysis of carbamazepine side effects associated with bone metabolism, folate and vitamin B12 serum levels in Isfahan epileptic patients

Mohamad-Reza Najafi, Zahra Tolou-Ghamari


According to previous publications, chronic uses of AEDs reduce bone health, increase homocysteine levels, alkaline phosphates and many other biochemical changes. The aim of this study was to investigate carbamazepine (CBZ) effects on bone density, serum levels of folate, vitamin B12 and other biochemical variables. Twenty-one adult epileptic patients who received CBZ for treatment of epileptic attacks were enrolled. Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry method. Biochemical indices of bone metabolism, including serum calcium, phosphorus, alkaline phosphatase contents and also serum levels of folate, vitamin B12, homocysteine were measured. All clinical, laboratory and pharmacological data were recorded in d-Base and analyzed using SPSS (version 16) for windows. BMD Z-scores, and 25-dihydroxyvitamin D3 concentrations was not differ significantly, but it seems that, the female patients had diminished BMD at the femoral neck (p≤ 0.05). Folate or vitamin B12 levels tend toward lower values. This seems to be connected to a tendency toward higher mean corpuscular volume (MCV) with a mean of 84.9 fl (ranged from 59-120 fl). TWithin the population studied, there was no correlation between CBZC0 and homocysteine levels (p≤ 0.63). In compare to normal value the serum calcium content was lower with a mean of 7.8 mg/dl (ranged; 7.0-8.9 mg/dl; p ≤ 0.04). With a mean of 213 U/L serums alkaline phosphatase was significantly higher (p ≤ 0.01) than normal values. Due to the need for chronic prescription strategy in order to control convulsion attack, pharmacotherapy with AEDs may consequence to changes in serum contents of calcium, phosphorus, alkaline phosphatase in addition to decrease in BMD and increase in homocysteine levels. Further studies related to efficacy and side-effects of CBZ as the most prescribed AEDs in Iranian epileptic population seem to be valuable.


Carbamazepine; homocysteine; bone metabolism; folate

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